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January 10, 2011

Patients who Loathe Appearance Often Get Better, But It Could Take Years

by Sam Savage

A new study by Brown University psychiatrists finds evidence that given enough time, patients with body dysmorphic disorder frequently recover and rarely relapse. The surprisingly high rate may be related to patients in prior studies having had especially severe cases of the disease.

In the longest-term study so far to track people with body dysmorphic disorder, a severe mental illness in which sufferers obsess over nonexistent or slight defects in their physical appearance, researchers at Brown University and Rhode Island Hospital found high rates of recovery, although recovery can take more than five years.

The results, based on following 15 sufferers of the disease over an eight-year span, appear in the current issue of the Journal of Nervous and Mental Disease.

"Compared to what we expected based on a prior longitudinal study of BDD, there was a surprisingly high recovery rate and a low recurrence rate in the present study," said Andri Bjornsson, first author of the paper and a postdoctoral research fellow in the Department of Psychiatry and Human Behavior at the Warren Alpert Medical School of Brown University. He works in the BDD program at Rhode Island Hospital, run by co-author Katharine Phillips, professor of psychiatry and human behavior.

After statistical adjustments, the recovery rate for sufferers in the study over eight years was 76 percent and the recurrence rate was 14 percent. While a few sufferers recovered within two years, only about half had recovered after five years.

The subjects were a small group diagnosed with the disorder out of hundreds of people participating in the Harvard/Brown Anxiety Research Project (HARP). Study co-author Martin Keller, professor of psychiatry and human behavior and principal investigator of the HARP research program which has been ongoing for more than 20 years, said that because the BDD sufferers were identified through this broader anxiety study, rather than being recruited specifically because they had been diagnosed with BDD, they generally had more subtle cases of the disorder than people in other BDD studies. In comparing the HARP study with the prior longitudinal study of BDD, it is possible that the high recovery rate in the HARP study is due to participants having less severe BDD on average.

In fact, despite the sometimes-debilitating nature of the disorder, a third of those in this study were working full-time.

Acknowledging that many doctors are unfamiliar with BDD or may even be skeptical about the disorder, Keller said doctors should consider the light that these findings shed on the clinical progress of the illness.

"We want to make people aware of BDD "” aware that it exists and that it's a real mental illness," said Keller. "These people should be assessed very carefully and steered toward treatment very quickly."

In addition to Bjornsson, Phillips and Keller, other authors include Ingrid Dyck, Ethan Moitra, Robert L. Stout, and Risa B. Weisberg.